Sudden unexpected death in epilepsy is rare, but too common and there is an argument that every case should be reported, recorded and published so that we can learn from every death. In this special edition we have a series of papers on SUDEP and near SUDEP. It is likely that SUDEP has many aetiologies. An Italian paper reports ventricular fibrillation secondary to a seizure in a 44-year old male with medication resistant epilepsy. A UK series of 33 deaths in children with epilepsy identified that the majority of deaths were from co-morbidities rather than SUDEP. Roy Beran from New South Wales describes the expectations on Doctors to discuss SUDEP with their patients. There are differences between countries but also between physicians. Although there is a drive to discuss this sooner rather than later, the decision about when to discuss must remain within the judgement of the clinician. Although people with an intellectual disability and epilepsy are at increased risk of death, is the SUDEP risk mitigated by the supervision that many of these adults receive? 14/23 studies that were analysed identified intellectual disability as a risk factor for SUDEP. The UK epidemiological study of SUDEP from Cornwall identified that of the 48 cases identified, a number may have been preventable. This is both sobering and sufficient motivation to improve the care for all people with epilepsy.
